A recent study gives further evidence that prevalence of tobacco use is more in medical students than in general population. This becomes all the more paradoxical when India's 25 crore tobacco users look up at existing healthcare providers for assistance in quitting tobacco. Also it questions how serious are we to prevent needless diseases and deaths attributed to tobacco use, ponders Bobby Ramakant.

AIIMS (All India Institute of Medical Sciences) survey among medical students of North India conclusively proves that smoking in medical students increases as their medical schooling goes ahead.

"Tobacco Kills" or "Tobacco causes Cancer" says the new health warning on every tobacco pack. With young doctors and medical students not heeding to this health warning, has the tobacco control strategy went fundamentally awry?

Results of an AIIMS survey on smoking among medical students in Delhi and other parts of the region in North India sends a shiver down the spine — 56 percent of them smoke.

Furthermore most alarming was the fact that 35 percent of medical students surveyed were found to be "nicotine-dependent"!

The year-long survey was done by Department of Medicine at AIIMS with students from major medical colleges of North India answering questionnaires based on their smoking habits.

"This survey used the Fagerstrom test for nicotine dependence," said Dr Randeep Guleria, Professor of Medicine at AIIMS. This test was developed by Dr Karl Fagerstrom, a globally acclaimed authority in tobacco cessation.

"Dependence on smoking was assessed by the quantitative method with questions like number of cigarettes smoked every day and the time of lighting up the first cigarette after waking up," said Dr Guleria. He further added that "The motivation to stop smoking was assessed qualitatively by direct questions about intentions to quit."

37.5 percent medical students took to cigarettes after seeing others smoke, a further 32.5 percent smoked since they felt it was a stress-buster; 8.75 percent started due to "peer pressure," 11 percent were found to be "heavy smokers," and 45 percent had a "family history of smoking."

It is clear that the need to have a strong tobacco control and health education programme within healthcare settings is most compelling. Unless we have a health education programme in place, how else do we plan to reduce the number of medical students who may take up tobacco use during medical schooling?

If public health campaigns cannot bring in a change in medical students who 'believe' that tobacco is a stress-buster and smoke because of peer pressure or lifestyle imagery, then how effective will they be in general community?

However an overwhelming majority had tried to quit tobacco use. 65 percent had made attempts to quit, while 62 percent were willing to quit if assisted. Are we prepared and geared up enough to provide this 'assistance' ?

That brings us to the glaring gap in tobacco cessation services within healthcare settings. Unless tobacco cessation skills are imparted to mainstream healthcare providers utilizing and building upon existing infrastructure and health systems, how are we going to provide quality assistance to 62 percent of medical students who want to quit tobacco use?

Professor (Dr) Rama Kant, Head of the Tobacco Cessation Clinics at King George's Medical University (KGMU), says that "Doctors who use tobacco, endanger their own health, and send a misleading message to patients and to the public. The best way forward is to invest in building training capacities of existing tobacco cessation clinics so that these can impart not only cessation services, but also impart tobacco cessation skills in healthcare staff from different settings. It is also vital to integrate tobacco cessation counseling in routine medical practice."

The AIIMS survey indicates that the mean age of starting smoking was 18.65 years.

With deceptive tobacco advertising and misconceptions associated with tobacco use, the addiction takes roots before the age of 18, says Prof Kant. By the time tobacco-related hazards begin to manifest, the person, including medical students, is already addicted to nicotine dose. Nicotine is as addictive as heroin and cocaine, stated a US Surgeon General Report in 1988. It is not easy to quit tobacco, but it is also not impossible, asserts Prof Kant.

So far India has about 20 tobacco cessation clinics supported by World Health Organization across the country.

According to the Indian Council of Medical Research (ICMR) tobacco use is responsible for over 10 lakh deaths in India each year, which is about 3000 deaths every day.

The urgency to reduce or decimate preventable burden of life-threatening diseases attributed to tobacco is compelling.

Prof Kant points to a possible way forward – 'a combination of health education programme with tobacco control in focus to alarm new medical students and encourage them not to use tobacco should be incorporated while we scale up tobacco cessation services across the country,'

Bobby Ramakant, who serves as The Seoul Times' Asia correspondent, is a member of NATT, Network for Accountability of Tobacco Transnationals, and edits Weekly MONiTOR series, reporting violations of tobacco control policies as a senior public health and development journalist. He writes for newspapers in 11 countries and can be reached at bobbyramakant@yahoo.com)